Cervical dysplasia among women over 35 years of age


      The objective of the study was to review the cytologic and histopathologic features among women 35 years of age or older with cervical dysplasia.

      Study Design

      Patients presenting between 2001 and 2005 were included. Patients were labeled as pre- (PRE) or postmenopausal (POST) based on age younger than or 50 years old or older. Statistics were performed using SAS 8.0.


      Three hundred fifty-nine patients were identified: 270 PRE and 89 POST. PRE and POST patients had similar referral cytology with atypical cells of undetermined significance (ASC)/low-grade squamous intraepithelial lesion (LSIL) in 60% and 65% and high-grade squamous intraepithelial lesion (HSIL) in 35% and 27%, respectively. Among patients with ASC/LSIL, POST had significantly more cervical intraepithelial neoplasia (CIN) 3 (41% vs 29%; P = .027) as well as more malignancies (17 vs 0%; P = .002). Among patients referred for loop electrical excisional procedure secondary to HSIL cytology not explained by colposcopy, CIN 2 or greater was identified more often in POST (71 vs 32%; P = .03).


      Our data demonstrate a high proportion of severe cervical dysplasia in age groups traditionally thought to have less risk than younger patients.

      Key words

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        • American Cancer Society
        Cancer facts and figures 2007.
        American Cancer Society, Atlanta2007
        • Solomon D.
        • Davey D.
        • Kurman R.
        • et al.
        The 2001 Bethesda System: Terminology for reporting results of cervical cytology.
        JAMA. 2002; 287: 2114-2119
        • Lonky N.M.
        • Sadeghi M.
        • Tsadik G.W.
        • Petitti D.
        The clinical significance of the poor correlation of cervical dysplasia and cervical malignancy with referral cytologic results.
        Am J Obstet Gynecol. 1999; 181: 560-566
        • Manos M.M.
        • Kinney W.K.
        • Hurley L.B.
        • et al.
        Identifying women with cervical neoplasia: Using human papillomavirus DNA testing for equivocal Papanicolaou results.
        JAMA. 1999; 281: 1605-1610
        • Cox J.T.
        • Lorincz A.T.
        • Schiffman M.H.
        • Sherman M.E.
        • Cullen A.
        • Kurman R.J.
        Human papillomavirus testing by hybrid capture appears to be useful in triaging women with a cytologic diagnosis of atypical squamous cells of undetermined significance.
        Am J Obstet Gynecol. 1995; 172: 946-954
        • Cox J.T.
        The clinician's view role of human papillomavirus testing in the American Society for Colposcopy and Cervical Pathology guidelines for the management of abnormal cervical cytology and cervical cancer precursors.
        Arch Pathol Lab Med. 2003; 127: 950-957
        • Solomon D.
        • Schiffman M.
        • Tarone R.
        Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: Baseline results from a randomized trial.
        J Natl Cancer Inst. 2001; 93: 293-299
        • Wright T.C.
        • Cox J.T.
        • Massad L.S.
        • Twigs L.B.
        • Wilkonson E.J.
        2001 Consensus guidelines for the management of women with cervical cytological abnormalities.
        JAMA. 2002; 287: 2120-2129
        • Bruner K.S.
        • Davey D.D.
        ASC-US and HPV testing in women aged 40 years and over.
        Diagn Cytopathol. 2004; 31: 358-361
        • Kobelin M.H.
        • Kobelin C.G.
        • Burke L.
        • Lavin P.
        • Niloff J.M.
        • Kim Y.B.
        Incidence and predictors of cervical dysplasia in patients with minimally abnormal Papanicolaou smears.
        Obstet Gynecol. 1998; 92: 356-359
        • Flynn K.
        • Rimm D.L.
        Diagnosis of “ASCUS” in women over age 50 is less likely to be associated with dysplasia.
        Diagn Cytopathol. 2001; 24: 132-136
        • Rader A.E.
        • Rose P.G.
        • Rodriguez M.
        • Mansbacher S.
        • Pitlik D.
        • Abdul-Karim F.W.
        Atypical squamous cells of undetermined significance in women over 55.
        Acta Cytol. 1999; 43: 357-362
        • Kaminski P.F.
        • Sorosky J.I.
        • Wheelock J.B.
        • Stevens C.W.
        The significance of atypical cervical cytology in an older population.
        Obstet Gynecol. 1989; 73: 13-15
        • Massad L.S.
        • Behbakht K.
        • Collins Y.C.
        • Cejtin H.E.
        Histologic findings from the cervix among older women with abnormal cervical cytology.
        Gynecol Oncol. 2003; 88: 340-344
        • Keating J.T.
        • Wang H.H.
        Significance of diagnosis of atypical squamous cells of undetermined significance for Papanicolaou smears in perimenopausal and post-menopausal women.
        Cancer. 2001; 93: 100-105
        • Toplis P.J.
        • Casemore V.
        • Hallam N.
        • Charnock M.
        Evaluation of colposcopy in the postmenopausal woman.
        Br J Obstet Gynecol. 1986; 93: 843-851
        • Bulten J.
        • de Wilde P.
        • Boonstra H.
        • et al.
        Proliferation in “Atypical” atrophic pap smears.
        Gynecol Oncol. 2000; 79: 225-229
        • Cecchini S.
        • Bonardi R.
        • Mazzotta A.
        • et al.
        Testing cervicography and cervicoscopy as screening tests for cervical cancer.
        Tumori. 1993; 79: 22-25
        • Zahm D.M.
        • Nindl I.
        • Greinke C.
        • et al.
        Colposcopic appearance of cervical intraepithelial neoplasia is age dependent.
        Am J Obstet Gynecol. 1998; 179: 1298-1304